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Endocrinology: urinary frequency

Mrs Jackson is a 42 year old lady who attended her GP practice because she noticed a thick white discharge down below and was rather itchy. The GP does not know Mrs Jackson as she has just moved to the area and so reviews her notes prior to seeing her. She has no know medical conditions, but he notes that her BMI is 37.

Upon questioning Mrs Jackson admits that this is not the first time she has experienced these symptoms; in fact it has been occurring rather frequently but due to her embarrassment she had avoided attending sooner. The GP examines her and then kindly reassures Mrs Jackson that she has thrush, which he can easily treat with a tablet and some cream. Due to the recurrent nature of her problem the GP decides to ask a few more questions. Which underlying causes of recurrent thrush might he be considering?

Upon further questioning Mrs Jackson admits that she’s been feeling awfully thirsty lately, and her thirst never seems to be quenched no matter how much she drinks, and subsequently she has spent a lot of time in the bathroom. Which of the above underlying causes will the GP now consider most likely?

In light of these symptoms the GP decides to order a few tests. Which of the following investigations may be used to establish diagnosis?

Mrs Jackson returns a few days later to collect her results and the GP breaks the bad news, she has diabetes. Mrs Jackson appears to take the news in her stride and asks ‘what now?’. The GP goes on to discuss how management involves a number of components. What does the A to G approach stand for?

The GP sends Mrs Jackson home with some leaflets to process what he has told her and asks her to return in 2 days to organise a treatment plan. Upon her return more blood is taken to check her cholesterol, renal function etc. and her blood pressure is checked. Her BP is 170/110 on two separate occasions. Which of the following treatments would be first line for Mrs Jackson?

Mrs Jackson’s blood test results arrive and show that her U&Es are normal. Her cholesterol is 6.1. The GP decides to also start Mrs Jackson on a low dose of metformin. Which of the following side effects commonly associated with metformin might the GP warn her about?

What potentially fatal side effect of metformin would contraindicate the use of metformin had Mrs Jackson’s renal function been poor?

In addition, due to her high cholesterol the GP decides to start Mrs Jackson on a statin. Which enzymes do statins target?

Mrs Jackson goes away with her tablets and, with a few dosage adjustments, begins to make real progress with few side effects occurring. Mrs Jackson will next be seen at the GP practice diabetic review clinic.
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